Nutrition and Congruent Care Improve Wellbeing of Residents With Dementia in Slovenian Care Homes

Introduction: Current nutritional strategies for people with dementia focus on nutritional diets and regimens, although in recent years congruent care for people with dementia has been increasingly recognized to improve their wellbeing. This includes consistency of care, respecting the variability of psycho-sociological factors, emphasizing the importance of participation in activities, and congruence with the individual's needs and capabilities. When applied to the nutritional aspects of care, it aims to empower people with dementia to have an active role in their care and during meals. Congruent care has previously shown promising results in improving the quality of life of residents, reducing the incidence of negative social interactions and daily intake of medicines. Methods: A mixed methods qualitative-quantitative study was carried out. Out of 102 residential care homes for the elderly in Slovenia, a non-random sample of homes was selected. Seven homes that have implemented congruent care and five who have not implemented it agreed to participate. Content analysis of the transcripts of focus group interviews was carried out, to establish how the congruent care model was included into their everyday practice of care for people with dementia. Qualitative comparative analysis was used to describe the differences in the practice of care between the two groups of homes, in the fields of nutritional and general care. Frequencies and assigned importance of statements relating to different aspects of nutritional care were statistically compared. Results: The introduction of congruent care improved the wellbeing of the people with dementia, as observed by caregivers. The homes that had implemented congruent care gave more attention to the food choice aspects of nutritional care (p = 0.0474, 95%CICongruent = 50.77-72.35%, 95%CINon-congruent = 27.65-49.23%), while the homes that had not were more attentive to the dietary intake aspects (p = 0.0067, 95%CICongruent = 22.79-44.74%, 95%CINon-congruent = 55.26-77.21%). In the homes for the elderly that had implemented congruent care, both caregivers and management reported that the frequency of use of pro re nata medication decreased, which is supported by the results of the linear regression (R-adjusted(2) = 78.4, p = 0.005), although the data available is limited. Conclusion: First, the people with dementia in the care homes that had implemented congruent care were observed to have improved in mood, attitudes toward eating and wellbeing, as reported by caregivers. Second, the implementation of congruent care was well received by the management and caregivers of the care homes. A model of implementation of congruent nutritional care for people with dementia is presented.